The straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, will be published in May 2019.

Tuesday, September 5, 2017

Scorecard: Money and Longevity

United StatesItaly

Gross
Domestic Product per capita$57,467$30,527

Health
spending per capita
$9,892$3,391

Life expectancy at
birth78.8 years82.6 years

What’s Their Secret?

The main reason Italians get more bang for their
health care buck is that they have a single-payer National Health Service,
financed out of taxes. Everyone can see their own primary care doctor and be
cared for in the hospital without paying a penny, while medications, testing,
and specialist exams require at worst a tiny co-pay. Add in low income
inequality and a famously healthy lifestyle, and Italy has more than enough on
the plus side to compensate for its medical system’s many flaws.

6 comments:

A Medicare-style health care single-payer system for all needs to be addressed by the United States Congress. This appears doubtful as pharmaceutical charges and both in- and out-patient hospital charges greatly exceed actual costs!

I've always thought (hoped) "Obamacare" was just the first step toward single-payer, and it's starting to look like that's what going to happen when - I don't say if - Congress gets back in the hands of the Democrats. Nuts to the avaricious drug companies and hospitals!

Countries with universal health coverage obviously have a big advantage over the chaotic "capitalist" system in the United States. In the case of Canada, we have somewhat better outcomes at about half the cost per capita despite quite similar economies, societies, diets, etc.

In addition to the coverage system, another factor is the supply of doctors. Many of the countries with good health outcomes and low costs have higher density of physicians. Italy, for example, has 4.0 doctors per 1,000 population, compared to 2.6 in the United States. Greece, at 6.3, and Austria, at 5.1, have the highest ratios in the OECD. English-speaking countries are all below the OECD average of 3.4, except for Australia at 3.5.

Having more doctors per capita means they can give more personal care, spend more time with patients, listen to them more carefully, and even make house calls. Competition, as well as a national health systems, can keep costs down. There is an obvious advantage in having an education system (and immigration policy) that can produce more doctors. This also requires a society, culture, language, and economy that will keep the doctors from moving elsewhere--a problem for English-speaking countries whose doctors can move more easily to higher-paying jobs in the United States.

Having more doctors does not solve all problems--consider Russia with a 4.0 ratio--but it can certainly help. I don't have statistics, but I believe Cuba is a notable positive example.

Just a few observations from an old friend of Susan's in Calgary, Alberta, Canada.

Gloria and I lived with both kids in Copenhagen when I was on a Fulbright at the Danish Technical University. We could not get our CPR cards (the Danish equivalent of a Social Security card in the US) until we had specified our primary care physician. There was one in the same building as our apartment. The Danes what to make sure that if you have a health problem you have an entryway into their system.

They also take a more comprehensive view of public spending. The city planner in Copenhagen claimed that the government saves money with every kilometer of bike path the construct since health care costs are inversely correlated with the number of citizens who commute by bike.

Ah, Denmark! The perfect place to live if they only had the spaghetti and the weather. To be fair, Italians are all covered by the NHS and my American husband, when he finally gave in to my nudging and went to the local authorities, got to sign up free as a legal resident. And the Italian NHS, unlike the Danish variety, covers prescription medications. About the other side I can provide an equation: Rome streets + bicycle = death.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.